Call it sound therapy, auditory training or auditory intervention techniques; these therapy approaches have been the focus for investigation into many types of auditory processing disorders through out the world in prestigious institutions of higher learning by leading investigators.

Dr. Tomatis had a rather radical view of the transmission scheme that is 180 degrees out of phase from the traditional viewpoint. He believed that through a negative feedback loop originating at the level of the endolyph, hydraulic pressure was being applied to the ossicles along with middle ear muscle activity as a constant dampening and tuning of the tympanic membrane. The tympanic membrane collected the sound and transmitted it to the organ of Corti via the bony sulcus. Tomatis thus concluded it was the role of the middle ear to regulate sound transmission and provide a buffer for the shearing force required for audition. The human ear must maintain an optimal micro-homeostasis by limiting destructive shearing of the hair cells. Tomatis further believed that it was the middle ear muscles, which control high-frequency audition and have a significant role in cortical charging. (Figure 1)

(Figure 1)

Dr. Stephen Porges, at the University of Maryland (USA) working with children with autism and other related disorders, has focused on the two muscles of the middle ear. Porges states that the same nerves that control vocalization, facial expression, heart rate and breathing, innervate the tensor tympani and stapedius muscles. He points out that when the human organism is in a state of fear or high anxiety, the middle ear muscles loose the ability to diminish low-frequency sounds and attending to the higher frequencies of speech is thus impaired. Porges has developed an intervention protocol similar to the Tomatis method using filtered music to exercise the middle ear muscles along with whole body relaxation techniques to restore integrity to the middle ear muscle function and has reported improvements in communication skills, handwriting, balance and coordination, sensory processing, visual skill and sleep patterns. (Porges, 2003)

The research of Rideout and Laubach at Ursinus College in Collegeville, Pennsylvania required eight students to perform spatial-reasoning tasks before and after listening to a Mozart piano sonata. EEG recordings were made in each condition and an interesting correlation was observed. The music condition dramatically increased brain wave activity along with a significant increase in spatial-reasoning performance. (Rideout and Laubach 1997). Musical perception occurs in the right hemisphere of the brain, which is the same side of the brain that is involved with spatial analysis. (Roederer)

Dr. John Hughes, a neurologist at the University of Illinois Medical Center in Chicago found that music that regularly repeats every 20 to 30 seconds, just as most of Mozart’s compositions do, trigger the strongest brain activity. Dr. Hughes studied the effects of listing to Mozart on 36 subjects with severe epileptic seizures and found an outstanding 29 out of the 36 patients showed significant improvement by having fewer seizures of less intensity. (Hughes, John 1998)

Neurobiologist Gordon Shaw of the University of California at Los Angeles using MRI studies to chart the brain wave activity of individuals listening to different types of music found that only Mozart activated areas of the brain that process fine motor coordination, vision and other higher thought processing regions. (Rauscher, Shaw and Ky, 1995)

Dr. Ingmar Klochoff of Uppsala, Sweden, describes a psychosomatic syndrome, known as the tensor tympani syndrome and is caused by increased psychic tension due to mental stress. There are individuals who do not have a constant impedance of the middle ear. The conclusion for this irregularity was spontaneous tonic tensor tympani muscle activity. The symptoms of this syndrome are often a fullness, tinnitus and dysacusis with a high relation to tension headache and vertigo. This syndrome does not in its self cause hearing loss; however, persons with this syndrome complain of difficulties in understanding what people say. This psychosomatic syndrome is likely to be caused by an inability to attend or concentrate caused by the ever-present rise in psychic tension. (Klochoff 1979) (Figure 2)

(Figure 2)

The Centrifugal Pathways are where things start to get interesting. We all struggled with the afferent or input pathways and learned how things got to the brain, but it was that efferent or feed back system that always seemed to be so elusive and not very well understood. The efferent nerves run close to, but not within, the same tracts, as do the afferent nerves. The Superior Olivary Complex is the region of the brainstem where efferent neurons arise and have their point of origin, but are not within the afferent nuclei. It is this system that is responsible for the auditory reflex activities of the stapedius and the tensor tympanic muscles. Traditionally we have been taught that the contraction of these muscles causes the ossicles to become less efficient sound transmitters to the labyrinth, thus protecting the delicate hair cell structure. (Figure 3)

(Figure 3)

Unorthodox theories view this reflexive activity to be a tuning system that is continually monitoring the tension being applied to the tympanic membrane and providing protection to the hair cells from superatheshold stimuli.

The auditory efferent system is also feeding information back to the contractile outer hair cells pulling the tectorial membrane into the afferent inner hair causing a mechanical fine tuning effect as in attention and sound localization. (Figure 4)

(Figure 4)

These unorthodox theories have merit; in that a true feedback system would have a continuous flow of information that provides maximum tone to the middle ear muscles. Just like an arm or a leg that does not become completely limp when not in use, but maintains a proper tone all of the time, unless injured. This is one of the main theories of the Sound Therapy; that it will restore tone to the middle ear muscle system and in turn tunes up the entire auditory system, which is responsible for 85% of ongoing cortical activity

The system is also very global at a cortical level, sending information to the somatic and automatic nervous system. These more global responses are responsible for feelings of sadness, happiness, anxiety, flight and fight and a host of other visceral responses. It is the ears’ involvement with the X cranial nerve or the vagus nerve (some times referred to as the wandering nerve) that innervates the bronchi and heart going through the diaphragm and on to the entire viscera including the esophagus to the anus. Very simply put, “We therefore have a system in which reflexes can be established at many levels, and in which the cortex controls the reflexes through descending influences..”(Pickles 1988) )

Through over stimulation, sickness and disease, drug therapies and other oxidative stress, the integrity of the afferent and efferent nervous systems is compromised, with loss of muscle tone and synchrony in the synaptic firing order. This compromise manifests itself in myriad of symptomatic maladies, such as hearing loss, tinnitus, loss of balance and coordination, loss of attention, inability to hear and understand in the presence of background noise, fatigue, tiredness, headaches, anxiety, depression and on and on. So when damage occurs to this delicate feed back system, the homeostasis of the entire organism is compromised. Thus is appears through highly organized temporal stimuli (classical music), which has undergone high band pass filtration, a restoration of aural muscle tone and synaptic firing order provides better cortical processing. Better cortical processing corrects a myriad of problems ranging from: anxiety relief, better hearing, tinnitus control, better balance and coordination, to: feelings of happiness and well being.

It seems that it is the reestablishing of the ability to listen to the higher frequency that is responsible for repairing and reorganizing cortical pathways. The energy levels coming in from the high frequency areas are more intense than for the lower frequencies. Dr. Tomatis calls the high harmonics the “charging sounds” while he describes the lower frequencies as the “discharging sounds”. The lower frequencies supply inadequate energy to the cortex and may even exhaust the individual. (Weeks)

Roederer, Juan G. (1994) The Physics and Psychophysics of Music (pg 13 and 53) Springer-Verlag 1995

Weeks, B.S., The Therapeutic Effect of High Frequency Audition and Its Role In Sacred Music In T.M. Gilmore, P. Madeule, and B. Thompson (Eds.), About the Tomatis Method, Ontario, Canada: The Listening Centre Press

The Tomatis method is the foundation for numerous offshoots of sound therapy programs based on Tomatis’s discoveries. There is substantial evidence for the efficacy of the Tomatis method, with studies on a wide variety of health conditions producing a differing range of results that have been interpreted as either positive or neutral.

Tomatis reported in his autobiography on his efforts to collaborate with researchers. Though the methods used in some studies did not succeed in highlighting the positive results observed by clinical practitioners, Tomatis argued this was due to the design of the studies and individual variances. (Tomatis Conscious Ear)

In the last few decades there have been numerous controlled studies, surveys, clinical experiments and case histories, many of which confirm the benefits of the Tomatis method for a variety of conditions. A summary of these studies follows.

Reading, behavior and learning

Sandislands (1989) Compared 32 underachieving children with a control group of 40. The treated group showed greater improvements in listening, oral reading and behaviour.

Kershner et al (1990) undertook a 2 year study of 26 students with a control group using an auditory placebo. As improvements were found in both groups, researchers concluded that there was a lack of support for the educational efficacy of the Tomatis Program for learning disabled children.

Gilmor’s meta analysis (1999) covering four smaller studies of the Tomatis method, including Kershner’s work, found that “Positive effects sizes were found for each of the five behavioral domains analyzed”

Voice

Weiss (1985) found that three theatre students after seven months of Sound Therapy showed a shift of vocal energy to the higher frequencies and better articulation.

Language disorders

Van Wyk, (1974) compared 20 stutterers with 20 normal speakers and found that more stutterers have left ear dominance, confirming Tomatis’ hypothesis of the importance of right auditory laterality.

Jaarsveld (1974) found in a group of 43 stutterers, 82% got significant relief from the treatment and 54% retained the improvement for a year or more.

Badenhorst (1975) found that right-eared people communicate more easily, confirming Dr Tomatis’ theory of right ear dominance. Wilson (1982) found pre-school language disordered children showed statistically significant improvement in their ability to express thoughts and feelings in words. The study gives a strong indication that the Tomatis approach is useful when used with pre-school learning disabled children.

Swain (2007) studied the effects of the Tomatis Method on 41 subjects from age 4 to age 19 with auditory processing disorders. Standardized tests were used pre and post treatment. All subjects demonstrated statistically significant improvement with skills of immediate auditory memory, auditory sequencing, interpretation of directions, auditory discrimination and auditory cohesion. Researchers concluded that the Tomatis Method can be effective as an intervention strategy for auditory processing disorders. http://www.thelisteningcenter.net/research.php

Self Concept

Gilmor (1982) Found improvement in children and adolescents’ self concept, social and family relations and certain language and motor skills.

IQ

Rourke and Russel (1982) compared experimental and control groups and found improvement in IQ of learning disabled children under Tomatis treatment.

Dyslexia

Roy and Roy (1980) examined the effect of the Tomatis method on five dyslexic boys and showed improved cognitive control and audio-vocal control in four of the subjects.

Intellectual disability

De Bruto (1983) found a statistically significant increase in the mental age of profoundly disabled children after Tomatis treatment.

Autism

A study was undertaken by the University of California on autistic children using the Tomatis sound therapy, its findings were published in 2007. The method used was randomized, double-blind, placebo-controlled, crossover design. The study showed that there was improvement in the children, however it did not appear to be related to the treatment. The children that were given the placebo showed a higher percentage of improvement over those given the Tomatis treatment. The study concluded there was no improvement in language using the Tomatis Method.

Anxiety and depression

Peche (1975) studied a group of 10 students and found that Sound Therapy helps to alleviate anxiety and remove psychic blocks, indicating its benefits in conjunction with psychotherapy.

Botes (1979) found improved relationships and self-concept in an in depth study of three clients with neurotic depression.

Du Plesis (1982) in a long term study over 14 months with subjects carefully selected from a survey of 424 people, showed improved mental health and self actualization for both 10 anxious and 10 non anxious people as compared to a control group.

REFERENCES

Tomatis, A.A. The Conscious Ear. Station Hill Press. New York, 1991.

Sandislands, M. The Tomatis Listening Training Program: A Quasi-Experimental Field Evaluation, International Journal of Special Education 1989

In the 1940s Dr Tomatis, a Paris based ear, nose and throat specialist conducted clinical trials with singers, aeroplane mechanics and others to determine how their hearing was affected and whether it could be improved.

He went on to develop a method of treatment which addresses hearing and listening from both the physical and the psychological aspects. Through his experiments he also discovered that high frequency sounds, softly played stimulate and replenish brain energy, and are in fact essential for optimum functioning of the cortex.

Sound therapy research continues today all over the world. There is simply too much material to cover at once, so the following list is just a small collection of useful and insightful articles on the topic.

You can keep up to date on sound therapy research by visiting this site periodically, as we like to post on important findings in the field. Academic journals, search engines and social media forums on the topic are also good places to look.

Rafaele Joudry is the Founder and Director of Sound Therapy International. She has authored three books and designed a practitioner education program on Sound Therapy. She has completed her Masters and is currently leading a team of practitioners in Sound Therapy research. She is looking for Doctors interested in collaboration.

This paper contrasts and compares Sound Therapy based on discoveries by Dr Tomatis to music therapy, meditation, and various tinnitus treatments including masking, habituation retraining and intermittent masking with music. Tomatis based, Joudry Sound Therapy, has been found to have a more profound effect on ear function and the brain and nervous system for several reasons. It uses the power of classical music. It rehabilitates the middle ear via muscular exercise, it stimulates the brain with concentrated high frequency input and it reorganises brain pathways in a beneficial way by training the listener to be right ear dominant. A review of the clinical evidence points to the efficacy of the Joudry method particularly for the treatment of tinnitus.

PremiseJoudry Sound Therapy is an effective treatment for tinnitus because it directly stimulates the ear mechanism in such away as to improve both the mechanical, muscular function of the middle ear and the sensorineural function of the cochlea. It also activates many brain centres simultaneously, thus promoting the creation of new brain connections and better neural integration between auditory centres as well as integration with other sensory pathways.

Definition and Scope of Joudry Sound TherapyJoudry Sound Therapy is a treatment system based on the discoveries of the ENT Dr Alfred Tomatis. New treatment protocols and improved algorithms have advanced the therapy to render it more potent in the treatment of tinnitus and other ear related problems.

Background research

Music Therapy. Extensive evidence exists for the efficacy of music therapy in altering stress, mood states and assisting with a range of health disorders. In particular the music of Mozart has proven beneficial in assisting mood and also stimulating neurological connections and improving intelligence and short term memory.

Tinnitus – is learning to live with it still the best answer?Because no suitable drug therapy has been found for tinnitus there is a tendency to accept that the condition is untreatable. However stimulation and retraining methods have been found to deliver relief for the majority and in some cases total recovery.

Masking. Tinnitus masking was discovered in 1977 by Jack Vernon who observed that an external sound is easier to tolerate than an internal sound and went on to develop specialised devices for masking tinnitus. While helpful to some sufferers, this method was found effective in providing temporary relief only.

Habituation theory. In the 1980s Dr Pawell Jastreboff and Dr Jonathan Hazel, developed the theory of habituation which holds that tinnitus only becomes a problem if the limbic system is activated and the patient associates the tinnitus with stress or another negative emotion. Jastreboff developed Tinnitus Retraining Therapy which uses counselling and sound generators to train the patient not to pay attention to the tinnitus.

This method has gained wide acceptance in the audiology profession. It provides a measure of relief but requires a fair time commitment, and cost, as subjects must attend a course of training to learn the method.

Intermittent masking. In the 1990s a program was developed by Dr Paul Davis and marketed under the brand name Neuromonics. This program delivers a more tailored form of masking which has proved more palatable as it is delivered via music, giving an intermittent effect at a level tailored for the patient. However, the cost is prohibitive for many tinnitus sufferers. The efficacy of this method has not been verified by independent research.

Ear rehabilitation. Dr Tomatis’s discoveries provide a unique approach wherein ear function is rehabilitated using classical music processed with particular algorithms to create a stimulating effect for the ear. His work has been largely overlooked in the audiological field due to the fact that the short term treatment possible in the clinic setting was usually insufficient to produce the needed changes to affect tinnitus. However, the portable program developed by Joudry uses a different protocol which allows for more intensive, long term treatment, and is now proving to be highly effective in this area.

The improvements made to the Joudry program include:

Portability, meaning greater access and ease of long term listening

A more active musically responsive algorithm used in mastering

Audio-visual support materials to increase listener motivation and compliance

Convenience of use as listening can be done during daily activities or sleep

The physiological basis of Sound TherapyDr Tomatis in the 1950s invented a method of Sound Therapy where the frequencies in classical music are altered to provide a physical stimulus for the ear as well as the brain.

Tomatis advanced some radical ideas about the ear and nervous system for which he was acclaimed during his lifetime by the French academies of medicine and science. Several of his theories were tested and confirmed at the Sorbonne University. His premises, established through clinical observation included the following:

Efferent impulses activate the earThe middle ear mechanism is an active organ which responds via efferent nerve stimulus to incoming sounds. While generally thought of as passive, the middle ear muscles tend to be ignored in seeking remedial solutions for ear problems. Their only recognised role is generally the impedance of loud sound, which could damage the ear. However, Weeks and Richards through investigating the role of the cranial nerves and efferent impulses arising within the Superior Olivary Complex in the brain stem, confirmed that there is a voluntary and proactive component to our hearing. In fact it appears that we are continually tuning the middle ear in order to focus on sounds that we deem to warrant our attention.

Sound can improve ossicular performanceThe middle ear muscles can be activated by alternating high and low tones, leading to permanent improvement of their functioning. Tomatis made this discovery after many hours of clinical experimentation with his filtering device, the Electronic Ear. Though more interested himself in psychological aspects of hearing, and in treating autism and dyslexia, he laid the foundation for others to exploit his breakthrough for “ear physiotherapy.”

High frequencies reactivate the ciliaMoving through to the cochlea, Tomatis found that presenting the ear with increasing high frequency sound enhances the capacity of the ear to respond to high frequencies. He developed a program which progressively increases the high frequency content of the sound, increasing both tolerance and capacity for frequencies of 8,000Hz and above. Standard medical advice holds that if the cilia are damaged by noise or infection, they have most likely been destroyed and no improvement in hearing can eventuate. This has been called into question by a growing body of evidence that listening to the Joudry Sound Therapy, (an extended version of Tomatis) sometimes results in significant hearing improvement for sufferers of sensorineural hearing loss. This can only be explained by the premise that the hair cells in some instances were not destroyed but only damaged, and that the repeated stimulation by gradually increasing high frequencies helped to reactivate them.

Better ear function increases appreciation of soundTomatis asserted that the ear can be re-trained to receive a greater range of sound by repeated stimulus to “exercise” the middle ear muscles. Listeners to the Joudry method frequently confirm this finding by observing that their appreciation of sound improves, musical and vocal ability improve and they are able to hear birdsong and appreciate music in a new way. Along with this, following a conversation becomes easier, they can hear better in different environments and many report being able to turn down the TV so they can listen without annoying the rest of the family.

The right leads language integrationTomatis discovered that singing, speaking and all language skills are enhanced by ensuring right ear emphasis, which creates a shorter, more direct brain route for processing sound in the left hemisphere. While it is generally accepted that the primary processing centre for language is on the left, no one apart from Tomatis has used this knowledge to create a simple, auditory remedial program for laterality confusion and the resulting learning and language problems. Tomatis discovered this phenomenon by accident when working with singers who he found greatly improved their vocal range, control and fluency when monitoring themselves with the right as opposed to the left ear. He found that subjects could be trained to be right ear dominant by consistently supplying louder sound to the right ear.

High frequency bombardment improves brain energy and integrationPerhaps the most groundbreaking of Tomatis’s discoveries was that intensified high frequency sounds, primarily in the range of 8,000 to 16,000 Hz, consistently supplied, serve to stimulate and enhance brain function. This has implications for a wide range of brain disorders from depression to epilepsy, but also explains the benefit of the method to stress, anxiety and general wellbeing. Tomatis said that the brain needs to receive 3 to 4 billion stimuli per second for at least 4 ½ hours per day in order to function at optimum potential. Various forms of brain stimulation have been looked at for their therapeutic impact on dystonia, stroke rehabilitation, depression and chronic pain. By using classical music with augmented high frequencies, Tomatis found a way, via the auditory system, of making brain stimulus more acceptable and universally beneficial to the nervous system.

Supporting evidence for Tomatis’s discoveries Enhanced Brain states. Davidson of Madison University has studied the ability of humans to create and maintain positive emotional states and has integrated Western medical investigation with the teachings of Tibetan Buddhism by engaging in extensive enquiries with the Dalai Lama and other leading Tibetan lamas. Davidson’s research shows that certain centres in the left hemisphere of the brain, which are activated by meditation, contribute to more positive emotional states. This corroborates Tomatis’s discovery that stimulating the left hemisphere via the right ear emphasis produces beneficial results.

Classical music. Tomatis and Joudry Sound Therapy are delivered through classical music that has been altered to enrich the high frequencies, provide a right ear emphasis and present the ear with constantly alternating sounds of high and low tones in a particular algorithm, using Tomatis’s purpose made filtering system, the Electronic Ear. Western classical music is most suitable for this system due to the fact that it uniquely combines complex rhythm, melody and harmony to a greater degree than any other form of music, thereby stimulating numerous parts of the brain at one time. This is believed to enhance brain connectivity by causing connections to be formed by many diverse regions of the brain. Through experimentation Tomatis established that classical music was the most suitable type of music to use for Sound Therapy. The clinic based Tomatis method was used extensively to treat dyslexia, autism and a variety of listening or auditory processing disorders.

Tomatis research. A variety of beneficial effects of the Tomatis method have been recorded in research at specialised clinics in South Africa, Canada and Australia. These include benefits for dyslexia, anxiety and depression, language disorders, stuttering, mental retardation, learning difficulties, vocal quality and tinnitus.

Ear disorders showing improvement. The Tomatis method was made portable in 1984 by the Joudrys, so longer-term treatment became feasible as cost and convenience were dramatically improved. This led to evidence that on-going Sound Therapy can assist in certain cases with a number of ear related problems not previously considered treatable. These include various types of hearing loss: sensorineural, acquired hearing loss, industrial deafness, age related hearing loss and conductive hearing loss for which there is often a muscular component. They also include blocked ear, hyperacusis (sound sensitivity) cocktail party syndrome (difficulty hearing in a noisy room) and tinnitus (ringing in the ears.)

Data has been gathered for these effects through extensive written testimonials, surveys and clinical observations by some 200 allied health practitioners who recommend the method.

Evidence of success with tinnitusThere is extensive clinical evidence for the portable Tomatis (Joudry) method in the form of surveys, case histories and in depth interviews with clients.

A survey of Sound Therapy listeners found that 90% of tinnitus sufferers benefited from the method in that it reduced stress, anxiety and sleeplessness associated with the tinnitus. 45% experienced a reduction in the noise level and 7% found their symptoms were completely gone. Of hearing loss sufferers, 56% reported improvement. Improvements were observed through changes on audiograms, decreased volume required on Walkman or TV, being able to hear better in noisy environments, on the phone or when the speaker had their back turned. Such changes made a significant difference to the person’s life.

Numerous practitioners from various fields including musicians, psychologists, medical doctors and audiologists have become advocates and as independent practitioners actively promote and recommend the method.

Eric Jordan, a UK based audiometrician treated 200 to 300 tinnitus patients over a 2 year period and observed that 90% of patients benefited. Though not a formal study, this nevertheless constitutes objective, clinical observation of patients using the method in their day to day lives by a pracitioner interested and experienced in the tinnitus field.

As most of these results have been gathered from qualitative measures of actual clinical applications, including the personal reports from the clients on the impact on their lives, they are more informative than single quantitative measures from controlled research situations. More extensive research is needed to determine more precise statistics for the potential results in each category of hearing disorder. However, the information gathered so far leaves no doubt that Sound Therapy is beneficial to most people suffering from a hearing related complaint and that in many instances it can be quite life changing. The affordability of this method makes it a very favourable and low risk option for tinnitus sufferers when compared to other treatments available.

Summary of research by Elizabeth & Derek Rintel, 1995

SOUND THERAPY FOR THE LEARNING DISABLED CHILD: The Effect of High Fequency Filtered Music on Listening and Learning Ability

A group of Remedial Learning Children were exposed to Joudry Sound Therapy Tapes for 32 hrs over a period of sixteen weeks. The results were as follows:

Goldman-Fristoe-Woodcock Test of Auditory Discrimination

(in percentiles for age group)

Some comments from the discussion paper:

“we can conclude that the change was due to the high frequencies in the Joudry tapes.”

“Experienced teachers consider an increase of five months in reading in four months is good progress for a remedial child.”

“it is unusual for a group to make ten months gain in the period studied.”

“the children who received the high frequency music showed more rapid advances”

“For Special children being integrated into the classroom it is entirely feasible for an individual child to wear a Walkman player with the tapes while attending to lessons in the normal way. It is clear that larger group studies would be worthwhile especially in view of the policy of integrating as many disadvantaged children as possible into the normal school. Sound Therapy may allow them to speed up the learning process.”